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Title: Chronic Cerebrospinal Venous Insufficiency in relation to Multiple Sclerosis
Carlos Torres, MD
The Ottawa Hospital
Ottawa, Ontario
Timing: 7/1/10-6/30/12
Amount: C$102,866 over 2 years

Additional Personnel (all are affiliated with The Ottawa Hospital, the Ottawa
Hospital Research Institute and the University of Ottawa):
 Dr. Ian G. Cameron, Department of Diagnostic Imaging (MRI Unit)
 Dr. Matthew J. Hogan, Division of Neurology
 Dr. Mark E. Schweitzer, Department of Radiological Sciences and Department of
Diagnostic Imaging
 Dr. Cheemun Lum, Department of Diagnostic Imaging
 Dr. Miguel E. Bussière, Division of Neurology
 Dr. Santanu Chakraborty, Department of Diagnostic Imaging
 Dr. Mark S. Freedman, Division of Neurology (MS Research Unit)

Title: Investigation into Venous Insufficiency in Multiple Sclerosis
Anthony Traboulsee, MD
Medical Director, MS Clinic at UBC Hospital, Vancouver Coastal Health and University of BC
Vancouver, BC
Katherine Knox, MD
Saskatoon MS Clinic, University of Saskatchewan
Saskatoon, Saskatchewan
Timing: 7/1/10/-6/30/12
Amount: C$200,000 over two years
 The team is studying the prevalence of CCSVI in 200 people including those with MS
and controls without MS, using catheter venography, ultrasound, and magnetic
resonance venography.
 Unique to this study is the inclusion of family members, such as identical twins of MS
patients who have not developed MS, in control groups.
 The team hopes to verify the usefulness of non-invasive techniques that would make it
easier to screen for CCSVI, which would be needed if results from this and other
research confirm that future therapeutic trials are warranted.
 The research aims to determine the reliability and accuracy of different imaging
techniques for screening for CCSVI. This information will be needed if results from
this and other research confirms that future therapeutic trials are warranted.

Lyon wrote: Although true, it also seems to defy logic that among the most valuable study results might be those specifically aimed at disproving CCSVI.

If they use their negative creativity to prove there is nothing to CCSVI, go over their methods to find them valid or not. That's the value of skepticism, both positive and negative creativity are essential if we have any hope of finding the real answers.

Lyon wrote:

Jugular wrote: Worse, each of these studies plans on once again making use of Doppler ultrasound. Oh brother, here we go again.

I couldn't agree more. Someone HAS to come up with something less invasive and more accurate or this whole thing is just going to be a continuation of trying to make a case with faulty data.

It's a terrible conundrum in that it's no better to say that we need to wait because the science isn't here yet than it is to proceed with inconclusive tests.

The goal of the BC/SASK CCSVI study is to verify the condition itself, and the usefulness of non-invasive techniques to screen for CCSVI. This information will be much needed if results from this study, and other research projects being undertaken, confirm that future therapeutic trials are warranted. This study is the only funded project that will use three diagnostic tests to investigate how to image CCSVI. Specifically, we are investigating the use of catheter venography as the "gold standard" to detect CCSVI. This is more comprehensive than ultrasound alone. Both ultrasound and Magnetic Resonance Imaging of the veins (MRV) will be compared to catheter venography to determine which of these tests are adequate and reliable for detecting CCSVI in the near future.

scorpion wrote:Yet we got to this point through the use of ultrasound to detect CCSVI right? In his original study, from what I remember, Zamboni used ultrasound to detect "blockages".

According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement.

Moreover, ultrasonic methodologies are sometimes criticized as
being strictly operator-dependent and, in addition, TCCS is not a
technique widely in use. However, it should be noted that the proposed
ultrasonic assessment is a simple, non-invasive, reproducible
test that can easily be performed in the clinical setting, and there is
general agreement on the reliability of the proposed technique (Zipper
et al., 2002).

To conclude, altered venous haemodynamics could be an overlooked
piece in the complex MS puzzle, one that might explain the
possible contribution of venous drainage to the process of both
inflammation and neurodegeneration.

The ECD-TCCS protocol was performed once by a single team of investigators (EM and PZ: vascular technician and interpreting physician, respectively), thus not permitting the assessment of the intraobserver and interobserver variability coefficient. This is a limitation of our study because the assessment of the reproducibility of the proposed protocol, although beyond the aim of the present study, certainly deserves further investigation. However, it should be noted that our ultrasonic assessment can be easily performed in the clinical setting, and, despite the operator-dependency of ultrasounds, there is general agreement on the proposed technique

Lyon wrote: Its tough to believe that this study will not suffer the well known bias of Freedman : Although true, it also seems to defy logic that among the most valuable study results might be those specifically aimed at disproving CCSVI.

If they use their negative creativity to prove there is nothing to CCSVI, go over their methods to find them valid or not. That's the value of skepticism, both positive and negative creativity are essential if we have any hope of finding the real answers.